School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.
Nepean Blue Mountains Local Health District, Penrith, NSW, Australia.
J Clin Nurs. 2019 Nov;28(21-22):3725-3733. doi: 10.1111/jocn.15001. Epub 2019 Aug 8.
To uncover what is known about nurse-led models or interventions that have integrated palliative care into the care of patients with chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease is a highly symptomatic, incurable disease characterised by chronic symptoms that without appropriate palliation can lead to unnecessary suffering for patients and their caregivers. While palliative care practices can relieve suffering and improve quality of life, most palliative models of care remain cancer-focused. New models, including nurse-led care that integrates palliative care for patients with chronic obstructive pulmonary disease, could address patient suffering and therefore need to be explored.
A mixed-studies integrative review was undertaken. Seven databases were searched for articles published between 2008-2018. The PRISMA framework was applied to the search, and six studies met the review eligibility criteria. Content analysis of the articles was undertaken, and data were compared, looking for different nurse-led models and outcomes related to palliative care in chronic obstructive pulmonary disease.
Nurse-led, integrated palliative care models for patients with chronic obstructive pulmonary disease are rare and just four of the six articles found in this review had published results. Advance care planning was found to be the most common focus for nurse-led interventions in chronic obstructive pulmonary disease, and in all cases, results demonstrated an improvement in end-of-life discussions and completion of advance care directives. Of the reviewed articles, none used a qualitative framework to explore nurse-led models that integrated palliative care in chronic obstructive pulmonary disease.
While nurse-led advance care planning was one type of palliative care practice associated with positive patient outcomes, there is a need for deeper exploration of nurse-led models that holistically address the bio-psycho-social-spiritual needs of patients with chronic obstructive pulmonary disease, and their caregivers.
Integrating nurse-led supportive care clinics into chronic obstructive pulmonary disease services could be a way forward to address the unmet bio-psycho-social-spiritual needs of patients with chronic obstructive pulmonary disease, and their caregivers.
揭示关于将姑息治疗整合到慢性阻塞性肺疾病患者护理中的护士主导模式或干预措施的已知内容。
慢性阻塞性肺疾病是一种高度症状性的、不可治愈的疾病，其特征是慢性症状，如果没有适当的姑息治疗，可能会导致患者及其护理人员不必要的痛苦。虽然姑息治疗实践可以减轻痛苦并提高生活质量，但大多数姑息治疗模式仍然以癌症为重点。新的模式，包括将姑息治疗整合到慢性阻塞性肺疾病患者护理中的护士主导模式，可以解决患者的痛苦，因此需要进行探索。
进行了混合研究综合评价。检索了 2008-2018 年间发表的文章的七个数据库。应用 PRISMA 框架进行搜索，符合审查标准的有 6 项研究。对文章进行内容分析，并对数据进行比较，寻找与慢性阻塞性肺疾病姑息护理相关的不同护士主导模式和结果。
针对慢性阻塞性肺疾病患者的护士主导的姑息治疗综合模式很少，在本综述中仅发现了四篇符合条件的文章。在所有情况下，结果都表明，临终关怀计划的讨论和提前护理指令的完成有所改善。在综述的文章中，没有一篇使用定性框架来探讨将姑息护理整合到慢性阻塞性肺疾病中的护士主导模式。
虽然护士主导的临终关怀计划是与患者结果呈正相关的姑息治疗实践之一，但需要更深入地探讨整体满足慢性阻塞性肺疾病患者及其护理人员的生物-心理-社会-精神需求的护士主导模式。
将护士主导的支持性护理诊所整合到慢性阻塞性肺疾病服务中可能是解决慢性阻塞性肺疾病患者及其护理人员未满足的生物-心理-社会-精神需求的一种方法。
